Show:
Documenting & Reporting
start here
Legal/Ethical
Position
Did we cover that?
100
Used to record routine aspects of care, response to care, and intake & output.
What are Flow Sheets?
100
Giving as needed pain medication to a patient, prior to feeding another patient, prior to bathing a different patient.
What is prioritizing?
100
Forcing treatment on a patient.
What is battery?
100
Should be done prior to assisting a patient from wheelchair back to bed.
What is lock the brakes on the wheelchair?
100
Quality/level, chronology, aggravating or alleviating factors, and associated symptoms
What is how to chart a sign or symptom?
200
Documents scheduled, routine, PRN, STAT, or omitted doses and/or medications.
What is a Medication Administration Record (MAR)?
200
Side lying pressure ulcer risk.
What is the ilium
200
Can legally be shared with other health care providers at the patient's request.
What is information in the patient's chart?
200
Lifting with leg muscles, using a wide base, obtaining help, and asking a patient to help...
What is appropriate body mechanincs for moving and lifting a patient?
200
Fifth intercostal space, left midclavicular line
What is point of maximal impulse (PMI)?
300
Also known as a Client Care Summary.
What is a Kardex?
300
Patient's first line of defense against infection.
What is intact skin?
300
Includes regulations for handling infectious materials and toxic materials, & provides safeguards for radiation and electrical equipment.
What is The Occupational Safety and Health Act (OSHA)?
300
Placing hightop sneakers on feet for an immobile patient lying in bed to maintain dorsiflexion
What is providing correct body alignment?
300
Decreases the loss of body heat from the head
What is wearing a hat?
400
A formal record of an unusual occurrence or accident.
What is an Incident Report?
400
Enouraging and educating a stroke patient to utilize his non-affected side to assist in activities of daily living.
What is a nursing intervention?
400
Uses prayer and altered thinking to correct the causes of illness rather than traditional health care avenues
What is a Christian Scientist?
400
Provided to a patient with a loss of mobility and limited use of upper extremities.
What is passive range of motion?
400
A heart rate of 50 is considered
What is bradicardia?
500
This method is used to streamline charting and save time.
What is Charting by Exception?
500
The person a nurse consults when a patient is requesting "food from home" that has been brought in by family members.
Who is the dietician?
500
Proper documentation (not false documentation) generally ensures...
What is insurance reimbursment?
500
Slide the patient down your leg, gently to the floor
What is correct procedure to avoid injury for a patient falling?
500
Reviewing patient chart and care plan prior to beginning care for the patient uses
What is critical thinking skills to organize patient care?